Preoperative risk assessment for ambulatory sinonasal surgery.

OBJECTIVES: An increasing proportion of patients who are candidates for endoscopic sinus surgery can be treated as an outpatient. A preoperative risk assessment is needed to evaluate eligibility for day surgery. This study analyses the effectiveness of a risk assessment scoring system which examines medical, procedure-related, and socioeconomic factors. DESIGN: Prospective multicenter study. SETTING: Three center study including Klinik Hirslanden, Zurich, Switzerland, Luzerner Kantonsspital, Lucerne, Switzerland and HNO-Klinik München-Bogenhausen, Munich, Germany. PARTICIPANTS: Patients with endoscopic sinus procedures between January 1st, 2017 and December 31st, 2018. MAIN OUTCOME MEASURES: The "day surgery risk score" consisted of three subgroups with medical, procedure-related and socioeconomic risk factors were assessed to determine if these predicted the severity of postoperative complications. RESULTS: Three-hundred and one patients who underwent endoscopic sinus surgery were included. The score resulted in a median value of 5 [5, 5]. In the Receiver-Operating Curve (ROC-the true-positive rate against the false-positive rate), the Area Under the Curve (AUC) was 0.59 with 95% confidence interval from 0.49 to 0.69, indicating that the "day surgery risk score" may be no better at predicting the likelihood of a complication than a random classification model. CONCLUSIONS: The "day surgery risk score" is a straightforward risk assessment which combines medical, procedure-related, and socioeconomic factors. The score is easy to use but in trying to decide whether a patient is eligible for ambulatory endoscopic sinus surgery it did not predict whether a complication was more likely to occur.

TAS2R38 taste receptor gene and chronic rhinosinusitis: new data from an Italian population.

BACKGROUND: Chronic rhinosinusitis (CRS) is a frequent disease with high social impact and multifactorial pathogenesis. Recently, single nucleotide polymorphisms within the TAS2R38 gene have been implicated as possible contributors to the complex gene-environment interactions in CRS. The purpose of this study was to confirm the proposed correlation between TAS2R38 genotype, CRS and related comorbidities. METHODS: Fifty-three CRS patients and 39 healthy individuals were genotyped at the TAS2R38 locus. CRS patients were treated by endoscopic sinus surgery and medical therapies and subdivided in CRS with nasal polyps (CRSwNPs) and CRS without nasal polyps (CRSsNPs). The effect of genotype on CRS and CRS-related comorbidities was assessed. RESULTS: The distribution of the different genotypes at the TAS2R38 locus was not significantly different between CRS patients, either with or without nasal polyps, and controls. Besides, no association was found between the different genotypes at the TAS2R38 locus and CRS-related comorbidities. CONCLUSIONS: No association was found between TAS2R38 alleles or genotypes and CRS, thus questioning its role in the pathogenesis of CRS.

The effect of "Pyriform Turbinoplasty" on nasal airflow using a virtual model.

BACKGROUND: A new procedure, pyriform turbinoplasty, is described and nasal airflow is measured before and after this procedure in a virtual model. METHODOLOGY: Pyriform turbinoplasty is the submucosal reduction of the bone of the frontal process of the maxilla and the lacrimal bone. It opens part of the lateral margin of the nasal valve area with minimal damage to nasal mucosa. The resection of bone in this area can be extended by "nasal wall lateralization" when the lacrimal bone that joins the uncinate process behind the lacrimal duct as well as the base of the inferior turbinate and the edge of the maxilla at the rim of the pyriform aperture are removed. Nasal airflow was simulated using computational fluid dynamics and ANSYS Fluent solver. RESULTS: Analysis using fluid dynamics showed that these procedures help ventilation in the main airflow areas without substantially altering the normal pattern of airflow. CONCLUSIONS: The changes after performing a pyriform turbinoplasty seem to be an improvement when compared to the changes after inferior turbinate surgery that can misdirect the airflow largely through the inferior meatus.

Greater Palatine Canal: Computed Tomography-Based Anatomic Analysis And Clinical Significance for the Sinus and Skull Base Surgeon.

OBJECTIVE: Our aim is to describe the location and course of the greater palatine canal (GPC) by analyzing its relationship with anatomical landmarks that can be used during endoscopic sinus surgery. This information might help prevent injury to the neurovascular bundle. METHODS: A retrospective evaluation of paranasal sinus CT scans of 100 consecutive random patients, 200 sides, was performed. Five measurements related to the course of the GPC were conducted, from cranial to caudal. The anatomical landmarks were the inferior bony border of the sphenopalatine foramen to the cranial entrance of the GPC, the distance from the most dorsal, and inferior bony insertion of the middle turbinate and the inferior turbinate bones to the anterior margin of the GPC. The angle between the horizontal palatine bone and the GPC, its length, and the prevalence of osteophytes in GPC was also assessed. RESULTS: The mean distance of the inferior border of the sphenopalatine foramen to the cranial entrance of the GPC was 9.39 ± 1.72 mm. The mean distance of the dorsal insertion of the middle turbinate to the anterior margin of the GPC was 3.89 ± 0.93 mm. The distance of the dorsal insertion of the inferior turbinate to the anterior margin of the GPC was 3.16 ± 0.81 mm. The mean angle between the horizontal palatine bone and the GPC was 114.33 ± 10.92º and the mean length of the GPC was 30.23 ± 3.74 mm. None of the measurements showed a significant difference between the two sides. CONCLUSIONS: The landmarks used are easy to locate and assess on CT scans. These findings may help to make dissection safer in pathologies related to the pterygopalatine fossa, lateral sphenoid sinus or adjacent skull base.

Pyriform Turbinoplasty and Lateral Nasal Wall Lateralization: Practical Hints on How We Do It.

Pyriform turbinoplasty (PT) is a surgical option for the management of turbinate hypertrophy. The philosophy and goal of the procedure are to improve the symptoms of a restricted airway while preserving function. We report a case of surgical management of inferior turbinate (IT) hypertrophy with PT and lateral nasal wall lateralization (LNWL). PT and LNWL improve nasal airflow, providing a wider nasal cavity by the removal of the bone of the IT. Sustained symptomatic improvement has been documented and is less susceptible to the influence of turbinate hypertrophy with other techniques.

Adaptation and Validation of Portuguese Version of Olfactory Disorders Questionnaire (PT-ODQ).

Introduction Olfactory dysfunction (OD) is often a devaluated sensorial affection. The objective evaluation of this dysfunction doesn't evaluate its compromise in patients' daily life. Therefore, the use of a Portuguese-validated tool is of uttermost importance to objectively scale the pathology presented by these patients. Objective We aim to validate and cross-culturally adapt the Olfactory Disorders Questionnaire (ODQ) in the Portuguese language. Methods A prospective study was carried out to evaluate and compare 56 consecutive patients who had olfactory disorders and 54 asymptomatic controls. A cross-cultural adaptation process was taken into account in order to transform the original English tool into a valid Portuguese version. We explored the psychometric properties of the European-Portuguese version of the Portuguese version of ODQ (PT-ODQ) concerning its internal consistency, reproducibility, feasibility, and discriminatory validity. Results Cronbach alpha for the tool was 0.924 showing strong internal consistency. We also found a statistically significant difference in PT-ODQ between patients with olfactory disorders and patients without olfactory disorders, according to the Mann-Whitney test. Conclusions The PT-ODQ seems to be a valid tool for assessing the individual effect of olfactory disorders on patients' quality of life and, therefore, could be applied in olfactory disorders research and daily practice.

[Medical and surgical treatment options in the management of upper airway diseases]. / Konservative und chirurgische Behandlung der oberen Atemwege.

Rhinitis and sinusitis usually coexist and are concurrent in most individuals; thus, the correct terminology is now rhinosinusitis. Rhinosinusitis (acute and chronic, with and without nasal polyps) is defined as an inflammation of the nose and the paranasal sinuses characterised by two or more symptoms, one of which should be either nasal blockage, obstruction, congestion or nasal discharge (anterior and posterior nasal drip). For the acute rhinosinusitis one can state that the initial antibiotic treatment does not affect the outcome of the disease, therefore a symptomatic treatment as first line is adequate. Antibiotics are indicated after a prolonged phase of the disease with increase of the symptoms mainly after a period up to 10 days. An early treatment with topical steroids is most efficient in ARS. Chronic rhinosinusitis (CRS) is a multifactorial disease. Factors contributing can be mucociliary impairment, bacterial infection, allergy, swelling of the mucosa for another reason or anatomical variations in the nasal cavity. The ostiomeatal complex, a functional unit of the paranasal sinuses plays a key role in the pathogenesis of rhinosinusitis. The first line treatment strategy is medical treatment using topical steroids, long-term macrolide therapy and in severe cases short courses of systemic steroids. The role of surgery is defined to treat the residual disease after medical treatment. Surgery is primarily aimed at improving ventilation of the sinuses and restoring paranasal clearance.

Evaluation of an anatomic model of the paranasal sinuses for endonasal surgical training.

OBJECTIVES: To assess the suitability of a new anatomic model of the paranasal sinuses for endonasal surgical training. STUDY DESIGN: Prospective observational pilot study. METHODS: A new anatomic model of the paranasal sinuses was developed by the Department of Anatomy at the University of Zurich. The practicability of the model was evaluated by three experienced endoscopic sinus surgeons with a special focus on its possible use in training. Standardized surgical procedures were performed under simulated real-life conditions in the operating theatre. RESULTS: The endoscopic appearance of the nasal airway closely resembled real human tissue and the detailed anatomy of the model allowed the same structured surgical steps to be performed as in real life in the absence of bleeding. CONCLUSION: This anatomic model is a readily available teaching tool for endoscopic sinus surgeons.

Endoscopic unilateral transethmoid-paraseptal approach to the central skull base.

Objectives: The endoscopic technique in transnasal skull base surgery offers optimal visualization and free manipulation in the surgical field. However, it may cause approach-related sinonasal injury, influencing patients' quality of life (QOL). To minimize rhinological morbidity without restrictions in surgical manipulation and tumor resection, we introduced the unilateral transethmoidal-paraseptal approach. In this article, we analyzed the long-term results and sinonasal outcome of this technique. Study Design: Retrospective analysis of medical records. Methods: Forty-two consecutive patients underwent surgery between June 2010 and March 2014 using the transethmoid-paraseptal approach. Perioperative work-up included neurological, radiological, endocrinological, ophthalmological, and rhinological analysis. Patients' preoperative, 1-month and 1-year postoperative QOL was measured using the Sino-Nasal Outcome Test (SNOT-22). Results: At all individuals, a unilateral transethmoid-paraseptal approach was performed. Removal of the turbinates, posterior septal resection or a conversion to biportal surgery could be avoided in all cases. There were no intraoperative neurovascular complications. All patients had a notable improvement in any disease-related symptoms, as well as by objective criteria. Complete tumor resection was aimed in 39 cases and achieved in 31 of them. The SNOT-22 scores transiently worsened 1 month after surgery and non-significantly improved after 1 year, compared with the preoperative status. A subgroup of 7 patients with preoperative sinonasal disease evidence showed continuous significant improvement (p < .05) of SNOT-22 scores across time. The smell screening tests showed no significant difference across time. Conclusion: The described approach allows safe removal of various skull base lesions without deterioration in sinonasal QOL and smell function. Level of Evidence: 4.

Olfaction in rhinology--methods of assessing the sense of smell.

Olfactory disorders frequently occur in rhinological disease. Different subjective and objective test methods are available to assess the sense of olfaction. Among the subjective methods, screening tests and threshold measurements are commonly used to quantify hyposmia or anosmia. Qualitative methods are available using discrimination and identification tests. Objective methods are used in research and in some medicolegal situations. Objective tests include olfactory evoked potentials, functional Magnetic Resonance Imaging and functional Positron Emission Tomography. The measurement of the sense of smell helps to assess the whole spectrum of the effects of nasal disease. This is especially important before rhinological surgery, because a non-detected smell disorder in patients with rhinological disease is common. The assessment of a pre-existing hyposmia or anosmia helps to avoid a postoperative claim that this was caused by surgery. A variety of validated screening tests for olfaction is available and they are a useful tool to document whether a patient is able to smell.

Male subjects who could not perceive the pheromone 5a-androst-16-en-3-one, produced similar orbitofrontal changes on PET compared with perceptible phenylethyl alcohol (rose).

BACKGROUND: The aim of this study was to evaluate in how far cerebral blood flow changes in male subjects when exposed to a pheromone that they cannot consciously smell. METHODS: We used a boar taint steroid (5a-Androst-16-en-3-one), which is similar to human axillary sweat but could not be detected by the human volunteers who participated in this study. RESULTS: The pheromone produced activation of the orbitofrontal and frontal cortex in comparison to a baseline condition. The same regions were activated when the subjects smelled a rose-like odour. CONCLUSION: This study shows that a pheromone, which is not consciously detected, can evoke a response in the brain that is similar to a detectable odour.

Effects of sinus surgery in patients with cystic fibrosis after lung transplantation: a 10-year experience.

Chronic infectious rhinosinusitis with Pseudomonas aeruginosa is common in cystic fibrosis and may result in allograft infection after lung transplantation. Sinus surgery followed by nasal care may reduce these adverse effects. Sinus surgery was performed in 37 patients with cystic fibrosis after transplantation. Bacteriology of sinus aspirates (n=771) and bronchoalveolar lavage (BAL) (n=256) was correlated with clinical data. Sinus surgery was successful in 54% and partially successful in 27% of patients. A significant correlation between negative sinus aspirates and negative BAL and between positive sinus aspirates and positive BAL (P<0.0001) was found. Successful sinus management led to a lower incidence of tracheobronchitis and pneumonia (P=0.009) and a trend toward a lower incidence of bronchiolitis obliterans syndrome (P=0.23). Sinus surgery followed by daily nasal douching may control posttransplant lower airway colonization and infection. In the long term, this concept may lead to less bronchiolitis obliterans syndrome by decreasing bronchiolar inflammation.